Rajasthan University of Health Sciences, Jaipur

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Rajasthan University of Health Sciences, Jaipur Faculty of Nursing

FORM FOR REPORT OF THE INSPECTION OF NURSING COLLEGES

Session 20....-20.... Date of Inspection …………………….

1. RUHS Inspection order no……………………………date…………… Annexure-1

2. Type of inspection 1.First inspection

2. Renewal inspection

3. Any other

3. Nursing Programme: - 1. B. Sc. Nursing Sanctioned Seats

2. P. B. B. Sc. Nursing Sanctioned Seats

3. M.Sc. Nursing Sanctioned Seats

4. Details of Nursing College : - Annexure-2

Details filled by the Institution Remark of the Inspectors Remarks of the Scrutiny Committee

Name of Institute with

Address with pin code

Phone no.(s). with STD code

Fax no. (s).

E-mail Website

(Please attach latest month electricity / telephone bill copy for address verification.)

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5. Details of the Management- Society/ Trust/ Company/or other Body (to be specified clearly):-

(In case of Private Body, please attach a copy of Registration Deed along with list of members of the Apex Managing Body and a copy of constitution thereof)

Annexure-3

Particulars

Details filled by the Institution Remarks of the Inspectors Remarks of the Scrutiny Committee

Name

Specify nature - Whether Govt./ Society/ Trust/ Company/or other Body

Registration no. and date

Address with pin code

Phone no.(s). with STD code

Fax no.(s).

E-mail

Website

Name and contact no(s). of President/ Chairman

Contact No.(s).

Name and contact no.(s). of Secretary

Contact No.(s).

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6. Details of Affiliation Fee paid :- Annexure-4

S. No.

Course Session Intake Seats

Affiliation Fee paid to RUHS Remarks of the Inspectors Remarks of the Scrutiny Committee

Amount D.D. No. Date

1

2

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7. (a) Year of First Permission for the course by Govt. of Rajasthan, INC, and RUHS

(Attach a copy of permission letter) Annexure-5

S. No.

Authority Session Permitted Intake Seats Letter No. Date Remarks of the Inspectors Remarks of the Scrutiny Committee

1. Govt. of Rajasthan

B.Sc. Nursing _____ PB B.Sc. nursing _____ M.Sc. Nursing Medical surgical nursing _____ Child health nursing _____ Mental health nursing _____ OBG & Gynae nursing _____ Community health nursing _____

2. INC

3. RUHS

4.

5.

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(b) Subsequent renewals, if any, by Govt. of Rajasthan, INC, and RUHS: - (Please attach a copy of renewal letter(s)) Annexure-6

S. No.

Authority Session Permitted Intake Seats Letter No. Date Remarks of the Inspectors Remarks of the Scrutiny Committee

1. B.Sc. Nursing _____ PB B.Sc. nursing _____ M.Sc. Nursing Medical surgical nursing _____ Child health nursing _____ Mental health nursing _____ OBG & Gynae nursing _____ Community health nursing _____

2.

3.

4.

5.

8. Details of Principal of the College : - Annexure -7

Details filled by the Institution Subject Specialty Remarks of the Inspectors Remarks of the Scrutiny Committee

Name of the Principal with

Residential Address

Telephone No.(s). (Off.)

Telephone No.(s). (Res.)

Mobile No.(s)

Fax No.(s).

E-mail

College Website

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9. Details of teaching faculty: Annexure -8

The Above required information should be provided in separate sheet. Please attach online INC website faculty submission copy. Two Group Photos of Teaching duly verified by the Principal with date along with name of each individual on the photograph. Individual photos of all staff, duly verified by the Principal with date along with name of each individual on the photograph. Photocopy of PAN Card/Aadhar Card/ Voter ID Card & present address proof of all faculty. Attach their appointment/ joining letter, qualification certificate, experience certificate & relieving order from previous institution. Photocopy of attendance register of last 6 month. Please attach original affidavit of Rs-10 NJS regarding not working in any other institution from each faculty member. (Govt. Institute Exempted)

10. Details of Part time /External teachers

Please attach consent letter along with attendance of class Annexure -9 Sr. No

Name External Teacher

Qualification Subject Hours allotted Remarks of the Inspectors Remarks of the Scrutiny Committee

1

2.

2

4

5

Sr.

No.

Name of Faculty

Designation

D.O.B.

Date

Of

joining

Name of the institution, university,

year of passing

R.N.

R.M.

No.

Years of teaching

experience

Remarks of the

Inspectors

Remarks of the

Scrutiny

Committee

B. Sc.

Nursing

P B B Sc

Nursing

M. Sc.

Nursing

Ph

D

After B.Sc. /

P B B Sc

Nursing

After

M. Sc.

Nursing

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11. Details of students in each nursing programme:

Annexure -10

Programme I Year II Year III Year IV Year Total Remarks of the

Inspectors

Remarks of the Scrutiny Committee

B.Sc.(N) Male

Female

P.B. B.Sc.(N) Male

Female

M.Sc.(N)

Medical Surgical Nursing

Male

Female

(Child Health Nursing)

Male

Female

(Mental Health Nursing)

Male

Female

(OBG & Gynae Nursing)

Male

Female

(Community Health Nursing)

Male

Female

Note: Students details to be enclosed (name, father’s name, date of birth, date of joining, enrolment no. from RUHS)

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12. Details Of Office Staff : Annexure -11

Sr.

No.

Designation No. of Available staff Remarks of the inspectors Remarks of the Scrutiny Committee

1 UDC

2 . L.D.C.

3 Stenographer/P.A.

4 Accountant cum cashier

5 Librarian

6 Assistant Librarian

8 Peon/office attendant

9 Security Guard/ Chowkidar

10 Driver

11 Cleaner (Bus)

12 Sweeper

(Please attach copy of appointment letters, group photographs of office staff)

13 Details Of Hostel Staff Annexure -12

Sr. No.

Designation No. of available staff Remarks of inspectors Remarks of scrutiny committee

1 Warden

2 House Keeper

3 Cooks

4 Bearer

5 Sweeper

6 Chowkidar

8 Peon/ Ayah

9 Mali/ Gardner

10 Washer man /Dhobi

11 Cleaner (Bus)

(Please attach joining letter and group photographs)

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14 Land and Building: - (Only for first inspection or any change of address) Annexure -13

S. No. Particulars Details filled by the Institution Remarks of the Inspectors


1 Total Land Area (in sq. ft)

2 Build – up area of building (in sq. ft) (Building Completion Certificate by Authority & diaper sheet to be attached)

1. Teaching Block ................... 2. Boys Hostel ................... 3. Girls Hostel ...................

Total Build up area...................

3 Is the Building owned or on lease (if owned, please attach ownership title deed and if on lease, please attach lease/ deed agreement)

4 Layout of floor with area of individual spaces (in Sq ft.) Blueprint of Building to be attached. (visible & readable)

5 Principal office (size in sq. ft.)

6 Vice Principal office (Size in sq. ft.)

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Lecture Hall (Size in Sq. ft.)

B. Sc. Nursing

1

2

3

4

Post. Basic B. Sc. Nursing

1

2

M. Sc. Nursing

1

2

3

4

5

6

7

8. Nursing foundation lab (Size in Sq. ft.)

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9. Community Health Nursing Lab (Size in Sq. ft.)

10. Nutrition Lab (Size in Sq. ft.)

11. OBG and Paediatrics lab (Size in Sq. ft.)

12. Pre-clinical science lab (Size in Sq. ft.)

13. Computer Lab (Size in Sq. ft.)

14. A.V. Aids Room (Size in Sq. ft.)

15. Common Room (Male & Female) (Size in Sq. ft.)

16. Staff Room (Size in Sq. ft.)

17. Library (Size in Sq. ft.)

18. Multipurpose Hall (Size in Sq. ft.)

19. One room for each Head of Departments (Size in Sq. ft.)

20. Faculty Room (Size in Sq. ft.)

21. Provisions for Toilets (Size in Sq. ft.)

22. Record Room (Size in Sq. ft.)

23. Store Room (Size in Sq. ft.)

24. Total Build up area (Size in Sq. ft.)

25. Total Super build up area (20-30% of total build up

area)

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15 PHYSICAL FACILITIES Details of class rooms No. Of

Student Chairs Per

Class

Audio visual Aids Remarks of the Inspectors

Remarks of the scrutiny Committee

Type of

board

O.H.P.

LCD

Projector

Charts &

Models

Lecture room 1

Lecture room 2

Lecture room 3

Lecture room 4

Lecture room 5

Lecture room 6

Lecture room 7

Lecture room 8

Lecture room 9

Lecture room 10

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Assembly examination hall / Auditorium

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16. Details Of Laboratories (Please attach List of Article of each lab) Annexure -14

Nursing Foundation Lab

No. Beds/

Cradle

No. of Models

No. Of Dummies/

Dolls

List of articles

No. of Charts

No. of Chairs

No. of Cub-board

Hand washing facilities

Remarks of the Inspectors Remarks of the scrutiny Committee

M C H Lab

No. Beds/

Cradle

No. of Models

No. Of Dummies/

Dolls

List of articles

No. of Charts

No. of Chairs

No. of Cub-board



Community Health Nursing Lab

No. Cots

No. of Models

No. Of Dummies/

Dolls

No. of Community bags

List of articles

No. of Charts

No. of Chairs

No. of Cub-board



Nutrition Lab

Pakka Platform

Exhaust fan

Water Supply

Cutleries’

Utensils Food Grain Charts & Models

No. of Stove

Remarks of the Inspectors

Remarks of the scrutiny Committee

Pre-clinical Science Lab

No. of Models No. of Specimen

List of articles

No. of Charts

No. of Chairs

No. of Cub-board



Computer lab

Air conditioner

No. of Computer Internet Facility Xerox machine Scanner Printer Remarks of the Inspectors Remarks of the scrutiny Committee

Audio Visual lab

Television/LED OHP Internet Facility Charts/Posters/ Models

Video confereencing Facilities

LCD projector


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17. Details of Library:

S. No.

Particulars Details filled by the Institution Remarks of the Inspectors Remarks of the Scrutiny Committee

1. Room for librarian

2 No. of Reading Rooms

3 Library Hours

4 Seating Capacity

5 Total No. of Books (attach list of books) Annexure -15

a. Text

b. Reference

c. Other Books

6 Total No. of Magazines, Periodicals & News Papers subscribed :-

(please attach list) Annexure -16

a. Magazines

b. Periodicals

c. News Papers

7 No. of Professional Journals subscribed annually Annexure -17

a. Indian

b. International

d. Online subscription of journal

(attach photocopy of DD/Banker cheque)

Annexure -18

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8

No. of Journals available with back numbers. Please also enclose the List. Annexure-19

a. Indian

b. Foreign

c. Total

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No. of Books Purchased during last three years along with the amount spent Please also enclose copy of bills Annexure-20

No. Amount

a. Last Year

b. Second Last Year

c. Third Last Year

10 Name and qualification of Librarian (academic as well as professional qualifications) (Annexure -21)

11 List of other staff in the library ( Annexure -22)

12 Facilities in library

• Photo copying

• Internet /Wi-Fi

• Separate section for staff

13 Register maintained

• Accession register

• Journal register

• Issue register

14. Ground Rules of Library (Annexure -23)

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18. Hostel Facility: - Annexure-24 S.

No.

Particulars Details given by the Institution Remarks of the Inspectors Remarks of the Scrutiny

Committee

1 Layout and room floor area with details of individual

spaces in Sq ft (Please attach blueprint of the hostel

building) Separate for boys and girls (only for first

inspection)

2 Distance from

College

Hospital

3 Total No. of Rooms & Seats (Boys & Girls)

4 Percentage of students accommodated

5 Supervisory arrangement

6 Messing & Canteen arrangement

7 Availability of

CCTV on main entrance

Visitor’s room

Reading rooms

Recreation room

Indoor Games

Medical Facilities/Sick room

8 Proper and safe drinking water facilities (cool water

during summers), toilets and urinals, and common rooms,

Laundry, safe disposal of waste available for Boys and

Girls separately Proper fire safety arrangement available

in the hostel

9 Any additional facilities proposed to be provided

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19. Detail of Budget: Annexure-25 Sr. Particulars Details given by institute Remarks of the

Inspectors Remarks of the

Scrutiny Committee

1. Separate budget for the college.

2. Amount per Annum

3. name and designations of the drawing and disbursing authority

4. Last year’s budget allocation in Rs.

5 Financial Resources of institute

1.

2.

3.

4.

5.

6 Present financial position

7 Owned immovable property

8 In Trustee Securities

9 In Cash/in Bank/FDRs/Any Loan & others

10 Reserve Fund, if any

11 Expenditure

a Salary - Teaching staff - Non teaching staff

b Stipends for students

c New equipments and repairs

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d Linen and other household supplies

e Maintenance of vehicles and cost of petrol/ diesel

f Maintenance / Purchasing books, Journals, New papers, furniture and other items of library

g Office supplies including stationery and postage

12 Contingency fund – for educational tours, professional activities, prizes, entertainments, maintenance of the school premises and any other needed items

13 Incidental teaching equipment fund – (charts, films slides, transparencies, pen, chalk etc. )

N.B.: Attach • Last three financial year’s Audited Income and Expenditure Statement of the Institution.

• Present bank statement of institute

• Please attach copy of budget

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20. Mode of Payment to Teaching Staff: - Annexure-26

Sr. No.

Name of Staff Designation Gross Salary (per

month)

Mode of Payment

(Cash/cheque)

Name of Bank Bank A/c No. Cheque No. Remarks of the Inspectors

Remarks of the Scrutiny

Committee

• The required information may be provided in separate sheet

• Please attach form no. 16 of each faculty.

• Last three month bank statement of institute.

• Photo copy of last month cash book/ledger.

21. Sports & Recreation Facilities:- S.

No. Particulars Details Given by the Institution Remarks of the Inspectors Remarks of the Scrutiny

Committee

1 Provision for games

2 Details of social and cultural activities

3 Current Budget for games

22. Details of Clinical Facilities: - PARENT / AFFILIATED HOSPITAL Annexure-27

Sr. No. Name & Address of the Hospital

Number of Beds

Distance Arrangement for clinical teaching

Supervisory arrangement for

students



College Hostel

1

2

3

4

5

6

Note Please attach • Original Rs. 100 NJS affidavit regarding hospital. • Photocopy of last month IPD & OPD register of each hospital.

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23. Community Health Facilities ADOPTED VILLAGE

Sr. No. Particulars Details given by institute Remarks of the Inspectors Remarks of the Scrutiny Committee

1 Name of adopted village

2 Activity for school health

3 Activity for safe drinking water

4 Activity for sanitation

5 Activity for health check up

6 Activity for light & transportation

7 Participation in ongoing programme at PHC/CHC/SC

8 Any health serve/camp

RURAL FIELD Sr. No. Particulars Details given by institute Remarks of the Inspectors Remarks of the Scrutiny

Committee

1 Name of CHC/PHC/SC/Health centre

2 Adopted/Affiliated.

3 Administered by

4 Distance from the college

5 Area Coverage (in kms)

6 Number of villages covered

7 Population coverage

8 Service Rendered •_________________________ •_________________________ •_________________________ •_________________________

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URBAN FIELD Sr. No. Particulars Details given by institute Remarks of the Inspectors Remarks of the Scrutiny

Committee

1 Name of MCH & F.W. Center/Health centre

2 Adopted/Affiliated.

3 Administered by

4 Distance from the college

5 Area Coverage (in kms)

6 Number of villages covered

7 Population coverage

8 Service Rendered •_________________________ •_________________________ •_________________________ •_________________________

Note: A copy of the letter of agreement for affiliation to the Hospital and Health Centres to be attached. Annexure-28

24. Details Of Teaching Plan: Annexure-29

S.N. Batch Details given by Institute Remarks of the Inspectors Remarks of the Scrutiny Committee

Master Plan for Theory Class Time Table Teaching Plan

1 B. Sc. Nursing Part-I

2 B. Sc. Nursing Part-II

3 B. Sc. Nursing Part-III

4 B. Sc. Nursing Part-IV

5 P B B. Sc. Nursing Previous

6 P B B. Sc. Nursing Final

7 M. Sc. Nursing Previous

8 M. Sc. Nursing Final

Note: Please attach copy of master plan, class time table, teaching plan of each batch

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25. Details Of Clinical Rotation Plan: Annexure-30

(Graphic Rotation plan of each subject to be enclosed Batch

Subject

Details filled by institute



Size of student group

No. of

Rotation

Duration of

each rotation

Plan for learning

experience

B. Sc. Nsg. Part-I

Nursing foundation

B. Sc. Nsg. Part-II

Medical Surgical Nsg.-I

B. Sc. Nsg. Part-III

Medical Surgical Nsg-II.

Child Health Nursing

Mental Health Nursing

B. Sc. Nsg. Part-IV

Maternal Health Nsg.

Community Health Nsg.

P B B.Sc. Nsg. Previous

Medical Surgical Nsg.

Maternal Health Nsg.

Child Health Nursing

P B B.Sc. Nsg. Final

Mental Health Nursing


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M. Sc. Nsg. Previous

Advance Nsg. Practice

Nursing education

Medical surgical Nsg.

Child Health Nsg.

Mental Health Nsg.

OBG & Gynae Nsg.


M. Sc. Nsg. Final

Nursing Management

Medical surgical Nsg.

Child Health Nsg.

Mental Health Nsg.

OBG & Gynae Nsg


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26. Details of Records of student Sr. No. Particulars Details given by institute Remarks of the Inspectors Remarks of the Scrutiny Committee 1 Daily attendance register

2 Subject wise Class Attendance

3 Health record

4 Clinical and field experience record verified by hospital authority

5 Practical record books- procedure record- Midwifery case book

6 Leave record

7 Extracurricular activities of students

8 Cumulative record of each subject

9 Academic Record

10 Committee Meetings

11 Professional associations /Activities

TNAI Membership

• Name of unit SNA advisor

• Total number of TNAI member

• Total number of SNA member

27. Status & Compliance of last inspection: - S. No. Particulars Details given by the Institution Remarks of the Inspectors Remarks of the Scrutiny Committee

1 Last Inspection conducted on (in case of renewal)

2 Deficiencies pointed out in previous inspection

3 Position of deficiencies pointed out in previous inspection

4 Rectified completely

5 Partially rectified

6 Still persist (please mention reason thereof and proposed rectification time schedule)

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28. Other information/suggestion: -

Any other information/ suggestion the institution may like to furnish for consideration

Details given by the Institution Remarks of the Inspectors Remarks of the Scrutiny Committee

Certified that to the best of my knowledge & belief the requisite conditions for affiliation/ renewal have been satisfactorily fulfilled and that the institution possesses the necessary facilities in respect of staff, fund & accommodation etc. and that it is fit to be raised to the applied for standards.

Authorized signatory of Governing Body (Pl. attach copy of resolution thereof): Signature of Principal :

........................................... ........................................... ........................................... President/Chairman Secretary/Treasurer

Date & Time (Name) (Name) (Name) (Seal) (Seal) (Seal) Date & Time Date & Time Date & Time

______________________________________________________________________________________________________________________________________________________

(Submitted in reference to the order No. …………………………….……………….., dated…………issued by the Rajasthan University of Health Sciences, Jaipur)

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N.B.- 1. All concerned are advised to please go through each column carefully & with due caution before filling in the same as concealment or furnishing of any incorrect /wrong information/remarks may result in rejection of the application for affiliation.

2. Please attach photograph of college building elevation, all class room, all labs, library, principal & vice principal office.

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AFFIDAVIT ON REQUISITE RS. 100/- NON-JUDICIAL STAMP PAPER

(affidavit to be given by Chairman / President and the Secretary/Treasurer of the

Governing Body, duly attested by a first class magistrate or a Notary Public)

I ................................................................ S/o .....................................................

aged .............................. R/o .................................................... vide ......................................

resolution dated ............................................ of the Governing Body as their authorised

signatory in this regard hereby undertake that I shall abide by the provisions / directions

of Rajasthan University of Health Sciences, Jaipur and INC in all respects. I also further

declare that all informations given in the affiliation form/form for inspection for

affiliation duly signed by me are true and correct to the best of my knowledge and belief.

So God help me.

Date : ................... Place: ................... ..............................

DEPONENT

Name: .............................................

Designation: ..................................

Name of the Institution/ Body with seal

Attested by: ..................................................................... (Ist Class Magistrate/ Notary Public) (with seal)

25 Confidential

Rajasthan University of Health Sciences, Jaipur PROFORMA FOR REPORT OF THE INSPECTION

(To be filled by Inspectors/ Scrutiny Committee)

S. No. Particulars Remarks of the Inspectors Remarks of the Scrutiny Committee

1 Name of Institution with address

2 Course

3 Session

4 No. of Seats B.Sc. Nursing _____ PB B.Sc. nursing _____ M.Sc. Nursing Medical surgical nursing _____

Child health nursing _____

Mental health nursing _____

OBG and Gynae nursing _____

Community health nursing _____

5 Comments about- Teaching Faculty

Non-teaching staff

External teaching faculty

26 6 Comments and observation about

Time-tables

7 Comments and observation about available infrastructural facilities

Land

Building

Lecture Rooms

Other accommodation

Furniture

Library facility

Internet and Wi-Fi Facilities

Laboratories

Equipments & Apparatus

8. Clinical Facilities • Total No. of Beds • Equipments & Material supply

9.

Hostel facilities

Messing & Canteen

27 10. Games & Sports

• Indoor • Outdoor

11. Over all Observations about the Institute

12. Recommendations for grant of affiliation

DECLARATION:

1. Signature of Inspector

Name_____________________________

Designation _______________________

College ___________________________

Mobile ____________________________

2. Signature of Inspector

Name_____________________________

Designation _______________________

College ___________________________

Mobile ____________________________

Rajasthan University of Health Sciences, Jaipur

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